Events, trends, issues, ideas and journalism about health care and health in Kentucky

Sunday, January 21, 2018

Bevin's budget boosts efforts against opioid abuse but would cut several health programs, including poison control center

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Gov. Matt Bevin's proposed budget would boost programs that fight substance-use disorders and the state's over-burdened social-services system, but calls for cuts to other health-related programs, including the state's only poison control center and one that trains doctors in rural parts of the state.

Bevin's proposal to the General Assembly calls for an additional $34 million to fight the opioid epidemic, with a focus on helping pregnant women addicted to drugs. It also includes $24 million to hire more social workers and give raises to those already employed.

Medicaid, which covers about one-third of the state's population, is the state's largest health expense. The governor's budget recommendation for Medicaid is around $11.5 billion in the first year and $11.8 billion in the second year, mostly from federal funds. The Kentucky Hospital Association told Kentucky Health News that it was pleased with the numbers.

"It looked like there was just a minimal reduction so we were pleased that the budget maintained the funding for Medicaid," said Nancy Galvagni, senior vice president of the association. "We understand from talking with people at the Cabinet [for Health and Family Services] that they consider it funded going forward."

Administration officials told reporters at a Jan. 17 budget briefing that the Medicaid budget had been included in the governor's across-the-board 6.25 percent cuts, but the cut was taken from the projected need of the Medicaid program, not current funding.

The governor also proposed that 70 state programs lose all of their funding, with a projected savings of $85 million a year. At least nine of them related to health. Some haven't received state funding in recent years, but others have depended on it.

One of those is Norton Kosair Children's Hospital Poison Control Center, which is the state's only poison control center, serving all 120 counties. It received $729,000 in each of the past two fiscal years from the state, Joe Sonka reports for Insider Louisville.

Maggie Roetker, a spokeswoman for Norton Healthcare, told Sonka that the funding amounts to 43 percent of the poison center's $1.7 million annual budget. She said the federal government provides $234,000 and Norton makes up the rest.

Sonka reports that according to the center's current service contract with the state, it fields about 70,000 callers a year; saves Kentuckians more than $10 million a year by keeping people out of emergency rooms; and saves Kentuckians $3 to $5 million per year by consulting with patients who are already hospitalized by a poison, which decreases the length of their stay.

Another program set to lose funding is Madisonville's Trover Clinic, for a program that allows medical students from the University of Louisville to complete the last two years of medical school in rural communities. The Kentucky Center for Economic Policy reports that this program is scheduled to receive $910,000 in the fiscal year that ends June 30.

Two other health-related programs on the governor's chopping block include the Lung Cancer Research Grants Program at U of L and the University of Kentucky, which is getting $5,176,100 in the current fiscal year and the Autism Training Center, now getting $119,300, according to KCEP.

The budget would "eliminate state funding for five cancer research or prevention programs, including . . . screening programs for colon, breast, cervical and ovarian cancer," Linda Blackford reports for the Lexington Herald-Leader. But it includes $2.5 million each year in new money for the Pediatric Cancer Research Trust Fund, for brain-cancer research at the two universities, which would have to each provide $1.2 million to match the state appropriation.

The fund was created in 2015 by Sen. Max Wise, R-Campbellsville, whose son Carter, now 10, had cancer when he was six months old. Wise said he and the universities asked for $9.8 million over two years. "It shouldn't be a competition, but unfortunately it is," Wise told Blackford. "We were not trying to play priorities or favorites."

The screening programs for breast and cervical cancer are operated with federal funds, so elimination of any state funds would not impact it, said Doug Hogan, spokesman for the Cabinet for Health and Family Services. Hogan said the colon-cancer screening program had not received state funds for several years.

"Health screenings for preventive services are covered by all insurance plans and there are no deductibles or co-pays," Hogan said. "That applies to various preventive screens including those for colon, breast and cervical cancers."

Jaimie Studts, professor of behavioral science at the UK College of Medicine, said the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative, also called the Kentucky LEADS Collaborative, has never received any state funding. He said it was slated to get $10,000 in each year of the current budget, but Bevin "red-lined" the allocation, saying the health secretary would need to determine how best to spend that money.

Including the program among the list of 70 to be cut "doesn't directly affect us in terms of dollars," Studts said. "But indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Some other health programs on the list hadn't received any funding from the state for the past several years: ARC of Kentucky, a group that supports people with intellectual and developmental disabilities, and Madison County Early Intervention Services. They were not scheduled to get any funding in the 2018 fiscal year, according to KCEP. It has published a list of programs proposed for elimination and the current appropriation for each.

Bevin says his cuts are necessary to fully fund the state's pension obligations, with his budget setting aside about $3.3 billion, or 15 percent of state spending, for that purpose.

Opponents of the governor's budget cuts are calling for raising new tax revenue through comprehensive tax reform, which the governor said could happen in 2018. However, his office said in his budget news release that "He is calling for genuine tax reform that will make Kentucky more competitive with its neighboring states -- not merely a bump in the sales tax or an increase in the cigarette tax."

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. For our site that features articles of lasting importance, go here.